Provider Demographics
NPI:1740863638
Name:YON, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:YON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14117 KENLEY WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4003
Mailing Address - Country:US
Mailing Address - Phone:405-227-2522
Mailing Address - Fax:
Practice Address - Street 1:14117 KENLEY WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4003
Practice Address - Country:US
Practice Address - Phone:405-227-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies